| NPI | 1205384633 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: OH S.1802709) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: None) |
| Enumeration Date | 2016-09-14 |
| Last Update Date | 2018-09-12 |