| NPI | 1700855129 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: OH E669) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: OH I1464) |
| Enumeration Date | 2006-03-16 |
| Last Update Date | 2007-07-09 |