| NPI | 1255695383 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OH I.1450622-SUPV) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: OH l.1450622) |
| Enumeration Date | 2012-07-03 |
| Last Update Date | 2021-08-24 |