| NPI | 1023410164 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: OH S.0031386) |
| Additional Taxonomies | 104100000X Social Worker (Licence: OH S.0031386) |
| 106H00000X Marriage & Family Therapist (Licence: OH S.0031386) | |
| Enumeration Date | 2014-09-19 |
| Last Update Date | 2024-05-15 |