| NPI | 1063938124 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: OH C0002935) |
| Additional Taxonomies | 104100000X Social Worker (Licence: OH S0002722) |
| Enumeration Date | 2017-08-20 |
| Last Update Date | 2019-05-22 |