| NPI | 1891294310 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: OH I.2304998-SUPV) |
| Additional Taxonomies | 104100000X Social Worker (Licence: OH I.2304998) |
| 104100000X Social Worker (Licence: OH 1600496) | |
| Enumeration Date | 2018-02-10 |
| Last Update Date | 2025-05-12 |