| NPI | 1942451505 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: OH I.1801310) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: OH S00028121) |
| Enumeration Date | 2008-10-01 |
| Last Update Date | 2018-11-27 |