| NPI | 1992184162 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: OH I.1201562-SUPV) |
| Additional Taxonomies | 104100000X Social Worker (Licence: CA 29068) |
| Enumeration Date | 2015-05-21 |
| Last Update Date | 2015-05-21 |