| NPI | 1255648184 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OH I.1200584) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: OH S.0900857) |
| Enumeration Date | 2010-09-14 |
| Last Update Date | 2012-06-28 |