| NPI | 1003552464 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OH E.2607698) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OH C.2103347-TRNE) |
| 101Y00000X Counselor (Licence: OH C2204712) | |
| Enumeration Date | 2022-05-09 |
| Last Update Date | 2026-10-01 |