| NPI | 1588183453 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OH E.2001739) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 106H00000X Marriage & Family Therapist (Licence: OH M1900095) | |
| 106H00000X Marriage & Family Therapist (Licence: OH F.2100158) | |
| Enumeration Date | 2017-09-12 |
| Last Update Date | 2022-05-10 |