| NPI | 1356540918 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OH c.2002583-TRNE) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: OH PTA 05728) |
| Enumeration Date | 2007-07-13 |
| Last Update Date | 2020-08-27 |