| NPI | 1174974117 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OH I.1801239) |
| Additional Taxonomies | 104100000X Social Worker (Licence: OH S.1600314) |
| Enumeration Date | 2016-06-30 |
| Last Update Date | 2021-03-28 |