| NPI | 1134287964 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: OH E.0000162-SUPV) |
| Additional Taxonomies | 104100000X Social Worker (Licence: OH E000162) |
| Enumeration Date | 2006-12-05 |
| Last Update Date | 2023-02-13 |