| NPI | 1710520648 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OH E.2303973) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OH C.1801453) |
| Enumeration Date | 2019-10-23 |
| Last Update Date | 2024-01-23 |