| NPI | 1750740619 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: OH E.1800702-SUPV) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OH C. 1400400) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OH E.1800702-SUPV) | |
| Enumeration Date | 2016-02-19 |
| Last Update Date | 2021-01-13 |