| NPI | 1225192461 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IN 34001364A) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: OH I0004769) |
| Enumeration Date | 2006-12-21 |
| Last Update Date | 2013-08-28 |