| NPI | 1174914642 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OH I.1901562) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: OH s1500026) |
| Enumeration Date | 2015-02-05 |
| Last Update Date | 2023-01-18 |