| NPI | 1780728931 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OH I.0009570-SUPV) |
| Additional Taxonomies | 104100000X Social Worker (Licence: OH I9570) |
| Enumeration Date | 2007-02-19 |
| Last Update Date | 2021-12-21 |