| NPI | 1568086833 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OH E.2202940) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OH C.2002613) |
| Enumeration Date | 2020-06-03 |
| Last Update Date | 2022-06-20 |