| NPI | 1730536350 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OH I.1700562-SUPV) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: OH T 1302209o) |
| Enumeration Date | 2016-05-24 |
| Last Update Date | 2023-10-11 |