| NPI | 1326612862 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 104100000X Social Worker (Licence: OH S.1904097)  | 
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator | 
| Enumeration Date | 2021-05-19 | 
| Last Update Date | 2021-05-20 |