| NPI | 1669046447 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: OH S.2604954-TRNE) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: OH LCDCII.161944) |
| Enumeration Date | 2021-05-17 |
| Last Update Date | 2026-03-20 |