| NPI | 1790266070 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OH I.2103306-SUPV) |
| Additional Taxonomies | 104100000X Social Worker (Licence: OH S.1802782) |
| 1041C0700X Social Worker, Clinical (Licence: OH I.2103306) | |
| Enumeration Date | 2018-08-24 |
| Last Update Date | 2024-08-08 |