| NPI | 1598209967 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: KY 258615) |
| Additional Taxonomies | 104100000X Social Worker (Licence: OH S.1600255) |
| Enumeration Date | 2016-12-05 |
| Last Update Date | 2024-01-18 |