| NPI | 1073041703 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: OH S.1700195) |
| Additional Taxonomies | 104100000X Social Worker (Licence: PA sw134151) |
| Enumeration Date | 2017-05-25 |
| Last Update Date | 2017-10-27 |