| NPI | 1730468646 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 083235) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: OH I. 0009416 SUPV) |
| Enumeration Date | 2011-08-09 |
| Last Update Date | 2015-05-26 |