| NPI | 1306206073 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: OH E.1100477) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: OH E.1100477) |
| Enumeration Date | 2016-02-24 |
| Last Update Date | 2023-12-29 |