| NPI | 1831102730 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OH I9281) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: OK 2772) |
| Enumeration Date | 2006-08-14 |
| Last Update Date | 2007-07-08 |