| NPI | 1083129282 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OH E.2102336) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OH C.1700837) |
| Enumeration Date | 2017-12-11 |
| Last Update Date | 2023-08-30 |