| NPI | 1518483783 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: NC 19061) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: OH C.1801229) |
| 101YP2500X Counselor Professional (Licence: OH E.2102460) | |
| Enumeration Date | 2017-08-18 |
| Last Update Date | 2024-11-13 |