| NPI | 1831485911 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TX 113272) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: OH I.2204018) |
| Enumeration Date | 2011-06-27 |
| Last Update Date | 2025-01-12 |