| NPI | 1386161891 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OH E1901429) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OH C.1500091) |
| Enumeration Date | 2017-08-25 |
| Last Update Date | 2019-10-07 |