| NPI | 1740791656 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: OH S1701462) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: OH S.1701462) |
| Enumeration Date | 2017-10-18 |
| Last Update Date | 2025-01-10 |