| NPI | 1023231453 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OH I 0000611) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MI 6801071403) |
| Enumeration Date | 2007-04-11 |
| Last Update Date | 2011-09-16 |