| NPI | 1164190641 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: OH C.2304813) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: OH C.2103474-TRNE) |
| 101YM0800X Counselor, Mental Health (Licence: OH E.2505454) | |
| Enumeration Date | 2021-08-31 |
| Last Update Date | 2025-06-25 |