| NPI | 1811596133 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OH E.2505464) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OH C.2002966) |
| Enumeration Date | 2020-10-19 |
| Last Update Date | 2026-03-12 |