| NPI | 1548215759 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OH I.0008327-SUPV) |
| Additional Taxonomies | 104100000X Social Worker (Licence: KY 1987) |
| Enumeration Date | 2006-05-24 |
| Last Update Date | 2018-04-24 |