| NPI | 1831284611 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: OH C0004390) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: OH S0007888) |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2007-07-08 |