| NPI | 1780226605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: OH 162459) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: OH S.2309631) |
| Enumeration Date | 2019-10-11 |
| Last Update Date | 2023-10-30 |