| NPI | 1346617545 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: OH E.1700409-SUPV) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: OH C1500056) |
| Enumeration Date | 2015-08-24 |
| Last Update Date | 2023-10-11 |