| NPI | 1053851758 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OH I.2002075) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: OH S.1700163) |
| Enumeration Date | 2017-02-28 |
| Last Update Date | 2021-08-02 |