| NPI | 1467941088 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OH I.1901480) |
| Additional Taxonomies | 104100000X Social Worker (Licence: OH S.1600912) |
| Enumeration Date | 2018-05-09 |
| Last Update Date | 2019-03-14 |