| NPI | 1871939777 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OH E.1100310) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OH E110310) |
| 101YP2500X Counselor, Professional (Licence: GA lpc012508) | |
| Enumeration Date | 2013-05-17 |
| Last Update Date | 2025-05-06 |