| NPI | 1669898094 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OH E.2202950) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OH C.1300309) |
| Enumeration Date | 2014-03-10 |
| Last Update Date | 2025-01-04 |