| NPI | 1417598756 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: SD LPC-MH30836) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: OH C.1000624) |
| Enumeration Date | 2019-10-07 |
| Last Update Date | 2023-12-29 |