| NPI | 1588204820 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 104100000X Social Worker (Licence: OH S.2106140)  | 
| Additional Taxonomies | 104100000X Social Worker (Licence: OH S1901187-TRNE)  | 
| Enumeration Date | 2020-01-15 | 
| Last Update Date | 2022-10-11 |