| NPI | 1134181753 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: OH E1892) |
| Additional Taxonomies | 104100000X Social Worker (Licence: OH S.0014079) |
| Enumeration Date | 2006-04-06 |
| Last Update Date | 2023-07-22 |