| NPI | 1083315337 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 103TS0200X Psychologist, School |
| 103TS0200X Psychologist, School (Licence: OH APP-000447544) | |
| Enumeration Date | 2023-03-14 |
| Last Update Date | 2023-03-22 |