| NPI | 1659734309 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OH E.1901498) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: OH C.1600143-TRNE) |
| Enumeration Date | 2016-03-31 |
| Last Update Date | 2019-12-11 |