| NPI | 1407524556 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OH I.2304266) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MA 227135) |
| 1041C0700X Social Worker, Clinical (Licence: MA 124515) | |
| Enumeration Date | 2021-09-02 |
| Last Update Date | 2023-05-08 |