| NPI | 1215410501 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OH C.1801246-TRNE) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OH C.2405708) |
| Enumeration Date | 2018-09-12 |
| Last Update Date | 2024-03-05 |