| NPI | 1821776030 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OH E.2505218-SUPV) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OH C.2304805) |
| Enumeration Date | 2023-07-07 |
| Last Update Date | 2026-08-14 |