| NPI | 1437115151 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WV DP00940211) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: OH I.0009145) |
| Enumeration Date | 2006-04-21 |
| Last Update Date | 2020-10-13 |