| NPI | 1376649236 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OH E0001043) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: OH I0001390) |
| Enumeration Date | 2006-09-16 |
| Last Update Date | 2007-07-08 |