| NPI | 1922535459 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OH I.2002091-SUPV) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| Enumeration Date | 2017-05-15 |
| Last Update Date | 2023-01-05 |