| NPI | 1558337410 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OH I.0800131-SUPV) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: IN 34004656A) |
| Enumeration Date | 2006-02-28 |
| Last Update Date | 2011-04-07 |