| NPI | 1538303946 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OH E0003150) |
| Additional Taxonomies | 104100000X Social Worker (Licence: OH S0017472) |
| Enumeration Date | 2009-04-29 |
| Last Update Date | 2016-02-09 |