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 |