| NPI | 1649545559 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OH I.1801104-SUPV) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: OH I. 0700281 SUPV) |
| Enumeration Date | 2012-03-12 |
| Last Update Date | 2023-05-03 |