| NPI | 1639291446 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: OH I3808) |
| Additional Taxonomies | 101YP1600X Counselor Pastoral |
| Enumeration Date | 2007-04-04 |
| Last Update Date | 2015-01-20 |