| NPI | 1104399260 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OH I.2002046) |
| Additional Taxonomies | 104100000X Social Worker (Licence: AZ LMSW-16798) |
| Enumeration Date | 2019-01-10 |
| Last Update Date | 2021-07-14 |