| NPI | 1912464421 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker |
| Additional Taxonomies | 101Y00000X Counselor (Licence: OH CDCA150240) |
| 104100000X Social Worker (Licence: OH s.2202550-TRNE) | |
| 251S00000X | |
| Enumeration Date | 2019-02-21 |
| Last Update Date | 2022-11-23 |