| NPI | 1306599147 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: OH C.2305567) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OH C.2203821-TRNE) |
| Enumeration Date | 2022-02-01 |
| Last Update Date | 2026-02-27 |