| NPI | 1083875736 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OH I1450876) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 070572) |
| 104100000X Social Worker (Licence: OH S1450317) | |
| 1041C0700X Social Worker, Clinical (Licence: NY 082274-1) | |
| Enumeration Date | 2008-06-24 |
| Last Update Date | 2015-03-03 |