| NPI | 1972040913 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: KY LCSW00001603) |
| Additional Taxonomies | 104100000X Social Worker (Licence: OH I.1901604-SUPV) |
| Enumeration Date | 2017-01-29 |
| Last Update Date | 2026-06-09 |