| NPI | 1386098549 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: I.1901606) |
| Additional Taxonomies | 104100000X Social Worker (Licence: OH S.1200588) |
| 1041C0700X Social Worker, Clinical | |
| Enumeration Date | 2016-04-14 |
| Last Update Date | 2021-03-04 |