| NPI | 1942557632 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OH E.1100184-SUPV) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OH E.1100184) |
| Enumeration Date | 2012-08-13 |
| Last Update Date | 2022-08-04 |