| NPI | 1720619372 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OH I.2304857) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: OH I.2034857) |
| Enumeration Date | 2020-02-03 |
| Last Update Date | 2024-03-04 |