| NPI | 1073011383 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OH E.2404151) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OH C.1800831-TRNE) |
| Enumeration Date | 2018-02-01 |
| Last Update Date | 2024-03-20 |