| NPI | 1720585748 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: NY 112807) |
| Additional Taxonomies | 104100000X Social Worker (Licence: OH S.1903336) |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2018-04-06 |
| Last Update Date | 2021-06-23 |