| NPI | 1962704916 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OH I.0000446) |
| Additional Taxonomies | 1041S0200X Social Worker, School (Licence: OH WV1-00-99480TR) |
| Enumeration Date | 2010-11-24 |
| Last Update Date | 2010-11-24 |