| NPI | 1285154625 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: OH C.1700476) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: OH E.2303542) |
| Enumeration Date | 2017-06-27 |
| Last Update Date | 2023-05-26 |