| NPI | 1649562133 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: OH F.1400011-SUPV) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OH C.0800103) |
| Enumeration Date | 2011-05-03 |
| Last Update Date | 2026-04-10 |