| NPI | 1588139125 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 104100000X Social Worker |
| 1041C0700X Social Worker, Clinical (Licence: OH S.1800373-TRNE) | |
| Enumeration Date | 2018-10-10 |
| Last Update Date | 2019-06-25 |