| NPI | 1952991051 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OH C1801465) |
| Additional Taxonomies | 163WG0000X Registered Nurse, General Practice (Licence: OH RN212255) |
| Enumeration Date | 2021-01-22 |
| Last Update Date | 2021-01-22 |