| NPI | 1215421060 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: OH S.1800499-TRNE) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: S1800499-TRNE) |
| 1041C0700X Social Worker, Clinical (Licence: OH I.2507606) | |
| Enumeration Date | 2018-06-15 |
| Last Update Date | 2026-03-19 |