| NPI | 1689064131 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WV DP00942276) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OH E0001820-SUPV) |
| 1041C0700X Social Worker, Clinical (Licence: OH I.0008643-SUPV) | |
| Enumeration Date | 2015-02-04 |
| Last Update Date | 2022-12-05 |