| NPI | 1104475649 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OH I.2203512) |
| Additional Taxonomies | 104100000X Social Worker (Licence: OH 1903920) |
| Enumeration Date | 2019-09-07 |
| Last Update Date | 2024-11-06 |