| NPI | 1457931784 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CT 6263) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OH C.2002503-TRNE) |
| Enumeration Date | 2021-04-12 |
| Last Update Date | 2024-05-10 |