NPI | 1629521257 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OH E.1300112-SUPV) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OH E.1300112-SUPV) |
Enumeration Date | 2016-08-01 |
Last Update Date | 2025-03-13 |