| NPI | 1932778651 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: OH C.2204071) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: OH C.2103280-TRNE) |
| 101YM0800X Counselor, Mental Health (Licence: OH C.2204071) | |
| Enumeration Date | 2021-06-18 |
| Last Update Date | 2022-06-29 |