| NPI | 1932141587 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OH I1700183) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: PA SW122475) |
| Enumeration Date | 2006-06-11 |
| Last Update Date | 2025-08-18 |