| NPI | 1861582074 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: KY 3686) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: OH I 0009889) |
| Enumeration Date | 2006-10-16 |
| Last Update Date | 2016-01-25 |