| NPI | 1457815912 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OH C.1901780) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MO 2018043307) |
| Enumeration Date | 2019-01-29 |
| Last Update Date | 2019-07-15 |