| NPI | 1255989562 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OH I.0004915) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OH I.0004915) |
| Enumeration Date | 2019-08-29 |
| Last Update Date | 2024-11-04 |