| NPI | 1356540918 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: C.2103790) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: OH PTA 05728) |
| Enumeration Date | 2007-07-13 |
| Last Update Date | 2025-10-31 |