| NPI | 1376093989 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OH E.1901178-SUPV) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OH C.1300645) |
| Enumeration Date | 2016-10-06 |
| Last Update Date | 2025-04-10 |