| NPI | 1760705198 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: OH I-0700163-SUP) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: OH I-0700163 SUPV) |
| Enumeration Date | 2010-03-12 |
| Last Update Date | 2023-04-10 |