| NPI | 1821588732 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: OH C180.1022) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OH E.2303927) |
| Enumeration Date | 2018-05-16 |
| Last Update Date | 2024-07-10 |