| NPI | 1174287312 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: CO SWC.0000001670) |
| Additional Taxonomies | 104100000X Social Worker (Licence: OH S.0028519) |
| Enumeration Date | 2021-10-25 |
| Last Update Date | 2024-07-31 |