| NPI | 1013912112 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OH I.0000580-SUPV) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: OH I 580) |
| 106H00000X Marriage & Family Therapist (Licence: OH F 092) | |
| Enumeration Date | 2005-06-15 |
| Last Update Date | 2023-07-11 |