| NPI | 1669046447 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: OH LCDCII.161944) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OH QMHS) |
| Enumeration Date | 2021-05-17 |
| Last Update Date | 2023-10-25 |