| NPI | 1427240829 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: OH I0027324) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: OH I0027324) |
| Enumeration Date | 2007-08-10 |
| Last Update Date | 2008-10-24 |