| NPI | 1710190418 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: OH I-1815) |
| Additional Taxonomies | 104100000X Social Worker (Licence: KY KY SW 163) |
| 106H00000X Marriage & Family Therapist (Licence: OH F0500018) | |
| 106H00000X Marriage & Family Therapist (Licence: KY SW 163) | |
| Enumeration Date | 2007-05-08 |
| Last Update Date | 2007-07-08 |