| NPI | 1477028413 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: OH S.2005684) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: OH LCDCIII161925) |
| Enumeration Date | 2018-10-05 |
| Last Update Date | 2024-11-27 |