NPI | 1548631617 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OH I.1700207) |
Additional Taxonomies | 104100000X Social Worker (Licence: OH S.1451404) |
Enumeration Date | 2015-10-14 |
Last Update Date | 2017-06-28 |