| NPI | 1013040963 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: OH I2504) |
| Additional Taxonomies | 104100000X Social Worker (Licence: OH I2504) |
| 1041C0700X Social Worker, Clinical (Licence: OH I2504) | |
| Enumeration Date | 2007-03-13 |
| Last Update Date | 2007-07-08 |