| NPI | 1588103485 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OH E.2102417-SUPV) |
| Additional Taxonomies | 104100000X Social Worker (Licence: OH S.1700038) |
| Enumeration Date | 2017-02-13 |
| Last Update Date | 2024-08-21 |