| NPI | 1386366342 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OH I.2406190) |
| Additional Taxonomies | 104100000X Social Worker (Licence: OH S.2106751) |
| Enumeration Date | 2022-09-16 |
| Last Update Date | 2025-01-17 |