| NPI | 1164536413 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OH E2903) |
| Additional Taxonomies | 104100000X Social Worker (Licence: OH S22878) |
| Enumeration Date | 2006-08-17 |
| Last Update Date | 2019-01-06 |