| NPI | 1760996763 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: OH I.2002196) |
| Additional Taxonomies | 104100000X Social Worker (Licence: OH S.1701073) |
| Enumeration Date | 2017-11-29 |
| Last Update Date | 2020-08-06 |