| NPI | 1548769243 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OH I.1901817) |
| Additional Taxonomies | 104100000X Social Worker (Licence: OH S.1700250) |
| Enumeration Date | 2018-02-08 |
| Last Update Date | 2020-07-13 |