| NPI | 1144528332 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: OH S.0700443) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: OH I.1200439) |
| Enumeration Date | 2011-03-11 |
| Last Update Date | 2014-03-10 |