| NPI | 1699975482 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IN 34005053A) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: OH I05000088) |
| Enumeration Date | 2007-07-20 |
| Last Update Date | 2013-03-20 |