| NPI | 1568053247 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: OH S.2207842) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: OH S.2101690) |
| Enumeration Date | 2021-01-27 |
| Last Update Date | 2022-06-20 |