| NPI | 1104228642 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OH I.2103188) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OH I.2103188) |
| 104100000X Social Worker (Licence: OH S 1450685) | |
| Enumeration Date | 2014-09-16 |
| Last Update Date | 2024-06-21 |