| NPI | 1134606247 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OH E.2404262) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OH C.1700205) |
| 101Y00000X Counselor (Licence: OH C.1700205) | |
| Enumeration Date | 2018-07-21 |
| Last Update Date | 2026-05-29 |