| NPI | 1831693712 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: OH I.1800766-SUPV) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: OH I1800766) |
| Enumeration Date | 2018-03-23 |
| Last Update Date | 2023-02-20 |