| NPI | 1730672171 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WV 3265) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OH E.2606175) |
| Enumeration Date | 2018-06-11 |
| Last Update Date | 2026-08-14 |