| NPI | 1245371178 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: OH E3261) |
| Additional Taxonomies | 104100000X Social Worker (Licence: OH S17449) |
| Enumeration Date | 2007-02-12 |
| Last Update Date | 2007-07-08 |