| NPI | 1548283260 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OH S-6081) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: OH 981340) |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2007-11-01 |