| NPI | 1588984603 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NM 0206781) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: OH E0700288S) |
| 101YM0800X Counselor, Mental Health (Licence: OH E0700288S) | |
| Enumeration Date | 2010-06-11 |
| Last Update Date | 2023-08-16 |