| NPI | 1487707238 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IN 34004747A) |
| Additional Taxonomies | 104100000X Social Worker (Licence: OH 1440065) |
| Enumeration Date | 2007-01-18 |
| Last Update Date | 2015-03-05 |