| NPI | 1184285322 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OH S.2005215) |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2019-06-27 |
| Last Update Date | 2020-10-21 |