| NPI | 1265077812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OH I2102753) |
| Additional Taxonomies | 104100000X Social Worker (Licence: OH S.1600951) |
| Enumeration Date | 2019-11-07 |
| Last Update Date | 2021-06-17 |