| NPI | 1790212181 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OH E.2001586) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NY 007831) |
| Enumeration Date | 2017-05-16 |
| Last Update Date | 2020-02-21 |