| NPI | 1073096673 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OH C2103611) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: OH M.1800120-TRNE) |
| Enumeration Date | 2018-09-10 |
| Last Update Date | 2021-09-08 |