| NPI | 1710176516 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: OH I0008237) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: OH I0008237) |
| Enumeration Date | 2007-10-17 |
| Last Update Date | 2008-11-10 |