| NPI | 1346839677 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: OH S.1202053-TRNE) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: OH S.1202053-TRNE) |
| Enumeration Date | 2021-01-12 |
| Last Update Date | 2021-04-15 |