| NPI | 1245842012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OH C.2103754) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: OH C2002556TRNE) |
| Enumeration Date | 2020-08-21 |
| Last Update Date | 2023-12-07 |