Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225C00000X | Rehabilitation Counselor |
NPI | 1063014397 |
---|---|
Provider Name | Dominic Robinson |
First Address | Beachwood, OH 44122-4314 |
Second Address | Beachwood, OH 44122-4314 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/11/2020 |
Last Update Date | 11/11/2020 |