| NPI | 1932649639 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: KY 252450) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: OH 1.2002319) |
| 1041C0700X Social Worker, Clinical (Licence: IN 34007629A) | |
| Enumeration Date | 2017-02-28 |
| Last Update Date | 2023-08-30 |