| NPI | 1649810821 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: OH E.2303879) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: OH C.1902013-TRNE) |
| Enumeration Date | 2020-01-15 |
| Last Update Date | 2023-12-20 |