| NPI | 1770895930 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 078945) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: OH I.1000184) |
| Enumeration Date | 2010-07-04 |
| Last Update Date | 2012-12-31 |