| NPI | 1053858159 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: OH S.1302664) |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2017-01-26 |
| Last Update Date | 2021-07-07 |