| NPI | 1487880316 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: OH E.0008476) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: IN 39004229A) |
| Enumeration Date | 2009-06-05 |
| Last Update Date | 2022-07-01 |