| NPI | 1871096321 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: KY 260304) |
| Additional Taxonomies | 104100000X Social Worker (Licence: OH I.1000032-SUPV) |
| Enumeration Date | 2018-03-12 |
| Last Update Date | 2025-07-22 |