| NPI | 1508261181 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OH E.1300461) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OH C1300461) |
| 101YP2500X Counselor, Professional (Licence: OH E.1300461) | |
| Enumeration Date | 2014-10-25 |
| Last Update Date | 2022-04-14 |