| NPI | 1174954176 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OH I.1451347) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: OH I-1451347) |
| 1041C0700X Social Worker, Clinical (Licence: KY 5103) | |
| Enumeration Date | 2013-12-02 |
| Last Update Date | 2018-03-17 |