| NPI | 1164950473 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NC 19873) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OH E.1901093) |
| Enumeration Date | 2017-05-31 |
| Last Update Date | 2025-04-22 |