| NPI | 1699256123 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OH I.2203341) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: OH S.190380) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH S.1800511-TRNE) | |
| Enumeration Date | 2018-08-23 |
| Last Update Date | 2024-01-29 |