| NPI | 1144654179 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OH S1200456) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OH S1200456) |
| Enumeration Date | 2013-08-27 |
| Last Update Date | 2013-09-16 |