| NPI | 1396143533 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OH E0701113) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OH E-0701113) |
| Enumeration Date | 2014-12-19 |
| Last Update Date | 2024-03-13 |