| NPI | 1861960080 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OH E.2303859) |
| Enumeration Date | 2018-11-06 |
| Last Update Date | 2024-07-30 |