| NPI | 1003552464 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: OH C2204712) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OH C.2103347-TRNE) |
| Enumeration Date | 2022-05-09 |
| Last Update Date | 2025-06-04 |