| NPI | 1649923442 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 104100000X Social Worker (Licence: OH S0029122) |
| Enumeration Date | 2022-02-01 |
| Last Update Date | 2023-02-22 |