| NPI | 1902317134 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 101743) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: OH I.2002414) |
| Enumeration Date | 2017-10-16 |
| Last Update Date | 2024-06-04 |