| NPI | 1245743939 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: OH E.1800668) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OH C0077084) |
| Enumeration Date | 2017-11-16 |
| Last Update Date | 2024-06-11 |