| NPI | 1902538218 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 104100000X Social Worker (Licence: OH S.2309449)  | 
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator | 
| Enumeration Date | 2022-06-27 | 
| Last Update Date | 2024-12-18 |