| NPI | 1932448156 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OH E.1200130-SUPV) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OH C.1200130) |
| Enumeration Date | 2013-02-07 |
| Last Update Date | 2023-01-11 |