| NPI | 1083112478 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL SW20734) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: OH I.1901840) |
| Enumeration Date | 2018-01-31 |
| Last Update Date | 2023-05-09 |