| NPI | 1518087519 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: OH C0600130) |
| Additional Taxonomies | 101Y00000X Counselor |
| 104100000X Social Worker (Licence: OH S0022101) | |
| Enumeration Date | 2007-03-31 |
| Last Update Date | 2019-11-04 |