| NPI | 1669695235 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: OH I-0800108) |
| Additional Taxonomies | 104100000X Social Worker (Licence: OH S0031093) |
| Enumeration Date | 2007-04-11 |
| Last Update Date | 2011-06-08 |