| NPI | 1083107064 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OH I.2103262) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: OH S.1802534) |
| 104100000X Social Worker (Licence: OH S.1802534) | |
| Enumeration Date | 2018-06-13 |
| Last Update Date | 2022-08-04 |