| NPI | 1952896052 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OH C.0007827) |
| Enumeration Date | 2018-06-30 |
| Last Update Date | 2025-01-31 |