| NPI | 1922024074 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: OH I0005568) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: OH I.0005568) |
| Enumeration Date | 2006-07-14 |
| Last Update Date | 2007-12-19 |