| NPI | 1588027593 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: OH I 8078 - SUPV) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: KY 0871) |
| Enumeration Date | 2016-03-29 |
| Last Update Date | 2016-03-29 |