| NPI | 1487370524 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CT 9149) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OH C-T.2204306) |
| Enumeration Date | 2022-10-19 |
| Last Update Date | 2025-11-21 |