| NPI | 1902201809 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OH E.1901518) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OH C1300707TRNE) |
| Enumeration Date | 2014-11-04 |
| Last Update Date | 2019-12-11 |