| NPI | 1912442906 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OH E.1901163) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OH C.1400579) |
| Enumeration Date | 2016-12-29 |
| Last Update Date | 2020-09-18 |