| NPI | 1235087206 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OH C.2304927) |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2026-03-17 |
| Last Update Date | 2026-03-17 |