| NPI | 1083963623 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OH E.1800649) |
| Enumeration Date | 2012-08-29 |
| Last Update Date | 2024-08-09 |