| NPI | 1619751195 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OH C.2305302) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: OH C.2305302) |
| Enumeration Date | 2023-08-24 |
| Last Update Date | 2024-08-12 |