| NPI | 1508539495 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OH I.2405788) |
| Additional Taxonomies | 101Y00000X Counselor |
| 104100000X Social Worker (Licence: OH S.2207310) | |
| Enumeration Date | 2021-07-27 |
| Last Update Date | 2025-01-21 |