| NPI | 1447752423 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: OH E.2303603) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OH C.1300402) |
| Enumeration Date | 2018-03-06 |
| Last Update Date | 2023-06-23 |