| NPI | 1730730334 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OH E.2001785-SUPV) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL TPMC1063) |
| 101YM0800X Counselor, Mental Health (Licence: PA PC013553) | |
| Enumeration Date | 2019-09-25 |
| Last Update Date | 2021-08-03 |