| NPI | 1023676186 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OH I.2304673) |
| Additional Taxonomies | 104100000X Social Worker (Licence: OH S.1903607) |
| Enumeration Date | 2019-06-04 |
| Last Update Date | 2023-08-07 |