| NPI | 1902348741 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: OH S 13103131) |
| Enumeration Date | 2016-11-10 |
| Last Update Date | 2022-04-08 |