| NPI | 1578914727 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OH I.1801163) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: OH S1600332) |
| Enumeration Date | 2016-06-29 |
| Last Update Date | 2018-08-21 |