| NPI | 1275854184 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OH I - 806 SUPV) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: PA CW015932) |
| Enumeration Date | 2010-06-15 |
| Last Update Date | 2010-06-15 |