| NPI | 1720459316 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OH C0500914) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OH E.0500914) |
| Enumeration Date | 2015-10-08 |
| Last Update Date | 2021-12-22 |