| NPI | 1194393488 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: VA 0701015732) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OH C.2204456) |
| 101YP2500X Counselor, Professional (Licence: OH C.2103296-TRNE) | |
| Enumeration Date | 2021-06-14 |
| Last Update Date | 2026-03-19 |