| NPI | 1194734830 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: WV CP00450613) |
| Additional Taxonomies | 104100000X Social Worker (Licence: OH S28255) |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2007-07-08 |