| NPI | 1760971774 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OH I.2304463) |
| Additional Taxonomies | 104100000X Social Worker (Licence: OH S.2005443) |
| Enumeration Date | 2018-05-04 |
| Last Update Date | 2023-06-08 |