| NPI | 1841414554 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: OH I.0009966-SUPV) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: OH I 0009966) |
| Enumeration Date | 2007-04-12 |
| Last Update Date | 2018-06-26 |