| NPI | 1063920155 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OH E.2102254) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OH C.1800869) |
| Enumeration Date | 2018-01-11 |
| Last Update Date | 2021-04-27 |