| NPI | 1821362153 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WV 2158) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: OH C.1801567) |
| 101Y00000X Counselor (Licence: WV 276481) | |
| 101YM0800X Counselor, Mental Health (Licence: WV 123) | |
| Enumeration Date | 2012-03-05 |
| Last Update Date | 2023-03-18 |