| NPI | 1821564469 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: OH I.2304518) |
| Additional Taxonomies | 104100000X Social Worker (Licence: OH 112919) |
| Enumeration Date | 2018-10-22 |
| Last Update Date | 2024-04-02 |