| NPI | 1063638518 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OH I-1101288) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: FL SW 8601) |
| Enumeration Date | 2007-04-17 |
| Last Update Date | 2012-10-09 |