| NPI | 1093249104 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OH S.1601260) |
| Additional Taxonomies | 104100000X Social Worker (Licence: OH 1601260) |
| Enumeration Date | 2017-04-14 |
| Last Update Date | 2018-11-06 |