| NPI | 1699941120 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OH I-1000365-S) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: OH S.0800068) |
| Enumeration Date | 2008-05-05 |
| Last Update Date | 2013-03-06 |