| NPI | 1114466422 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OH E.2606293) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OH C.0500333) |
| Enumeration Date | 2017-02-20 |
| Last Update Date | 2026-01-30 |