| NPI | 1104240407 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: KY 1649) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OH E.1600029) |
| Enumeration Date | 2014-02-07 |
| Last Update Date | 2023-06-16 |