| NPI | 1346230505 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: VA 0909008837) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: OH 0005378) |
| Enumeration Date | 2005-10-27 |
| Last Update Date | 2015-03-16 |