| NPI | 1932768470 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OH C.1901972) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OH E.2102320) |
| 101YP2500X Counselor, Professional (Licence: OH E.2102320) | |
| Enumeration Date | 2019-06-09 |
| Last Update Date | 2022-10-02 |