| NPI | 1225509755 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: AZ LPC-21741) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: OH C.1801069-TRNE) |
| 101YM0800X Counselor, Mental Health | |
| 101YM0800X Counselor, Mental Health (Licence: AZ LPC-21741) | |
| Enumeration Date | 2018-12-10 |
| Last Update Date | 2025-07-03 |