| NPI | 1275216301 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OH I.2608105) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: SC 18667) |
| Enumeration Date | 2023-08-07 |
| Last Update Date | 2026-05-04 |