| NPI | 1912330382 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: KY 252814) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OH E1600105) |
| Enumeration Date | 2013-08-20 |
| Last Update Date | 2022-02-28 |