| NPI | 1205607751 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NC A22977) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OH C.2406105) |
| Enumeration Date | 2024-01-12 |
| Last Update Date | 2026-06-17 |