| NPI | 1477945681 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: OH S.1451378) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: KS 5159) |
| Enumeration Date | 2015-02-25 |
| Last Update Date | 2020-04-17 |