| NPI | 1962503151 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OH I0700195) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: PA CW014440) |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2016-11-15 |