| NPI | 1356857650 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OH I.2002107) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: AZ LMSW-16287) |
| Enumeration Date | 2017-12-21 |
| Last Update Date | 2023-05-01 |