| NPI | 1376062109 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OH E.2203241) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OH C.1700225-TRNE) |
| 101YP2500X Counselor, Professional (Licence: OH C.1800969) | |
| Enumeration Date | 2017-09-13 |
| Last Update Date | 2022-12-07 |