| NPI | 1861506305 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NM I08401) |
| Additional Taxonomies | 104100000X Social Worker (Licence: OH I-0031470) |
| 1041C0700X Social Worker, Clinical (Licence: WV DP00942870) | |
| Enumeration Date | 2006-08-19 |
| Last Update Date | 2013-09-18 |