| NPI | 1013406255 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OH C2002511) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: OH C1901747) |
| 172V00000X Community Health Worker | |
| Enumeration Date | 2018-05-03 |
| Last Update Date | 2020-03-10 |