| NPI | 1942738216 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OH I.2203470) |
| Additional Taxonomies | 104100000X Social Worker (Licence: OH S1700440) |
| Enumeration Date | 2017-05-31 |
| Last Update Date | 2022-05-20 |