| NPI | 1104313691 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OH l.2204043) |
| Additional Taxonomies | 104100000X Social Worker (Licence: OH S.1600161) |
| Enumeration Date | 2018-04-19 |
| Last Update Date | 2022-12-05 |