| NPI | 1164905709 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OH I.2002236-SUPV) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: VA 0701003834) |
| Enumeration Date | 2018-09-10 |
| Last Update Date | 2021-10-15 |