| NPI | 1962466714 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OH 882503) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: OH 1-0009214) |
| Enumeration Date | 2006-04-17 |
| Last Update Date | 2009-10-20 |