| NPI | 1366687972 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: OH E0002536) |
| Additional Taxonomies | 104100000X Social Worker (Licence: OH S0009271) |
| Enumeration Date | 2008-12-10 |
| Last Update Date | 2008-12-10 |