| NPI | 1891207627 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OH I.2406157) |
| Additional Taxonomies | 104100000X Social Worker (Licence: OH S.1600969) |
| Enumeration Date | 2017-11-02 |
| Last Update Date | 2025-01-09 |