| NPI | 1679076806 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OH 50.008999RX) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OH C.1700347) |
| Enumeration Date | 2018-03-14 |
| Last Update Date | 2024-09-19 |