| NPI | 1124446828 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OH I1100169) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: KY 3493) |
| Enumeration Date | 2014-04-01 |
| Last Update Date | 2014-04-01 |