| NPI | 1063842789 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: E.1200348) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OH C.1200348) |
| Enumeration Date | 2013-11-15 |
| Last Update Date | 2023-05-15 |