| NPI | 1578033098 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OH I.0004783-SUPV) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MI 6801065763) |
| Enumeration Date | 2018-11-27 |
| Last Update Date | 2019-08-15 |