| NPI | 1275114738 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OH I.2203587) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: LA 12847) |
| Enumeration Date | 2021-04-16 |
| Last Update Date | 2022-07-26 |