| NPI | 1164462255 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IN 34007974A) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: OH I0003318) |
| Enumeration Date | 2006-06-07 |
| Last Update Date | 2023-11-27 |