| NPI | 1053619882 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: OH I-1000198) |
| Additional Taxonomies | 1041S0200X Social Worker School (Licence: OH OH 1518020) |
| Enumeration Date | 2011-03-02 |
| Last Update Date | 2011-03-02 |