| NPI | 1093855223 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WV DP00938589) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: OH I0008930) |
| Enumeration Date | 2007-02-07 |
| Last Update Date | 2022-04-06 |