| NPI | 1376850289 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: OH I 0800305) |
| Additional Taxonomies | 1041S0200X Social Worker School (Licence: OH OS1052431) |
| Enumeration Date | 2010-09-13 |
| Last Update Date | 2010-09-13 |