| NPI | 1629595822 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OH E.1700468-SUPV) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: OH E.1700468) |
| 101YP2500X Counselor, Professional (Licence: OH C1300151) | |
| Enumeration Date | 2017-08-28 |
| Last Update Date | 2024-10-23 |