| NPI | 1255994711 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: OH F.2200285) | 
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: OH M.1900102) | 
| Enumeration Date | 2019-04-19 | 
| Last Update Date | 2022-09-16 |