| NPI | 1871829895 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: OH I.0009259-S) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: IN 34005930A) |
| Enumeration Date | 2009-10-27 |
| Last Update Date | 2017-12-04 |