| NPI | 1790954493 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: OH I0500009) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: WV DP00941203) |
| Enumeration Date | 2008-02-27 |
| Last Update Date | 2008-02-27 |