| NPI | 1982876710 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OH I.1000154.SUPV) |
| Additional Taxonomies | 104100000X Social Worker (Licence: OH S.0500647) |
| 1041C0700X Social Worker, Clinical (Licence: OH I.1000154) | |
| Enumeration Date | 2008-04-01 |
| Last Update Date | 2012-10-05 |