| NPI | 1174774954 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OH I1201369) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: ME LC12647) |
| Enumeration Date | 2008-10-10 |
| Last Update Date | 2013-03-25 |