| NPI | 1992919591 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OH I.1000235-SUPV) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: FL SW6000) |
| 1041C0700X Social Worker, Clinical (Licence: PA CW017405) | |
| Enumeration Date | 2007-05-10 |
| Last Update Date | 2014-10-03 |