| NPI | 1447721956 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH23820) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OH E.2404232) |
| Enumeration Date | 2018-12-10 |
| Last Update Date | 2025-09-15 |