| NPI | 1518721000 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OH C.2305638) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CO LPCC.0021100) |
| Enumeration Date | 2024-02-06 |
| Last Update Date | 2024-02-06 |