| NPI | 1497152300 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OH I.1500071) |
| Additional Taxonomies | 104100000X Social Worker (Licence: OH S.1201056) |
| Enumeration Date | 2014-11-21 |
| Last Update Date | 2016-03-23 |