| NPI | 1235677279 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OH E.1901564) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OH C.1500589) |
| Enumeration Date | 2017-02-10 |
| Last Update Date | 2019-12-16 |