| NPI | 1003293267 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OH I.1801343) |
| Additional Taxonomies | 104100000X Social Worker (Licence: OH S1450434) |
| Enumeration Date | 2015-04-27 |
| Last Update Date | 2021-10-04 |