| NPI | 1073652475 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OH I-0005084) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: IN 34003244A) |
| Enumeration Date | 2007-02-05 |
| Last Update Date | 2007-07-09 |