| NPI | 1134637366 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: OH S.0500466) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: OH S.0500466) |
| Enumeration Date | 2018-01-23 |
| Last Update Date | 2020-02-13 |