| NPI | 1104935170 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OH E4358) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: OH S0016960) |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2016-04-15 |