| NPI | 1063876522 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OH E.2607457) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: OH C.1801490) |
| 101YP2500X Counselor, Professional (Licence: OH C.1801490) | |
| Enumeration Date | 2016-04-11 |
| Last Update Date | 2026-08-07 |