| NPI | 1962054148 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: OH I.2304550) |
| Additional Taxonomies | 104100000X Social Worker (Licence: KY 259375) |
| Enumeration Date | 2019-07-09 |
| Last Update Date | 2024-08-02 |