| NPI | 1356027171 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: KY 285198) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OH C2204465) |
| Enumeration Date | 2023-06-26 |
| Last Update Date | 2023-06-26 |