| NPI | 1740640499 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OH E.1901251) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OH 1700342) |
| Enumeration Date | 2016-02-23 |
| Last Update Date | 2024-03-10 |