| NPI | 1235799925 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OH I.2102602) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: OH 1700599) |
| Enumeration Date | 2019-06-16 |
| Last Update Date | 2021-03-04 |