| NPI | 1134370984 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MO 2014023114) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: OH I.1100131) |
| Enumeration Date | 2008-10-09 |
| Last Update Date | 2015-07-22 |