| NPI | 1235401688 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OH E.1000574-SUPV) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OH E.1000574-SUPV) |
| Enumeration Date | 2012-02-01 |
| Last Update Date | 2024-06-19 |