| NPI | 1689418451 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OH I.2507208) |
| Additional Taxonomies | 104100000X Social Worker (Licence: OH S.2309210) |
| Enumeration Date | 2024-06-25 |
| Last Update Date | 2025-10-20 |