| NPI | 1588647077 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: IN 39001707) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OH E.2203252) |
| 101YM0800X Counselor, Mental Health (Licence: KY 276908) | |
| Enumeration Date | 2005-11-29 |
| Last Update Date | 2025-11-10 |