| NPI | 1003401357 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: OH S.2207736) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH S.2101699-TRNE) |
| Enumeration Date | 2021-03-08 |
| Last Update Date | 2025-12-12 |