| 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 |