| NPI | 1205047271 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: KY 3512) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: OH I.1600689) |
| Enumeration Date | 2007-05-24 |
| Last Update Date | 2017-01-24 |