| NPI | 1245019751 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 405300000X Prevention Professional (Licence: OH RA.163619) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| Enumeration Date | 2023-09-25 |
| Last Update Date | 2023-09-25 |