| NPI | 1972189868 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: OH S.2208031) |
| Additional Taxonomies | 104100000X Social Worker (Licence: OH S.2101769-TRNE) |
| 251S00000X | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-03-22 |
| Last Update Date | 2022-08-15 |