| NPI | 1225557416 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OK 6136) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: OH I.0800326-SUPV) |
| Enumeration Date | 2017-09-19 |
| Last Update Date | 2017-09-19 |