| NPI | 1265833628 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OH E.0500137) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OH C0500137) |
| Enumeration Date | 2014-09-04 |
| Last Update Date | 2020-06-02 |