| NPI | 1548813397 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OH I.2203685) |
| Additional Taxonomies | 104100000X Social Worker (Licence: OH S.1803262) |
| Enumeration Date | 2019-07-22 |
| Last Update Date | 2026-06-09 |