| NPI | 1598907370 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IN 34005998A) |
| Additional Taxonomies | 104100000X Social Worker (Licence: OH I-0010290) |
| 1041C0700X Social Worker, Clinical (Licence: OH I.0010290SUPV) | |
| Enumeration Date | 2009-03-25 |
| Last Update Date | 2014-11-19 |