| NPI | 1912060286 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OH 0001647) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: OH F0000125) |
| 1041C0700X Social Worker, Clinical (Licence: OH E0001647) | |
| 106H00000X Marriage & Family Therapist (Licence: OH F125) | |
| Enumeration Date | 2006-12-18 |
| Last Update Date | 2013-09-27 |