| NPI | 1063540730 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OH E.0002985-SUPV) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OH E.0002985-SUPV) |
| Enumeration Date | 2007-03-02 |
| Last Update Date | 2024-11-10 |