| NPI | 1477082113 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: OH I.2102739-SUPV) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: OH S1700256) |
| Enumeration Date | 2017-06-07 |
| Last Update Date | 2022-04-01 |