| NPI | 1437283975 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: OH I.2102755) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| 1041C0700X Social Worker Clinical (Licence: CA 24503) | |
| Enumeration Date | 2007-03-15 |
| Last Update Date | 2021-04-13 |