| NPI | 1609374420 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OH C.2103090) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OH C.1902114-TRNE) |
| Enumeration Date | 2018-01-26 |
| Last Update Date | 2021-01-12 |