| NPI | 1538615323 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OH S.1600124) |
| Enumeration Date | 2016-08-31 |
| Last Update Date | 2025-02-27 |