| NPI | 1962025718 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OH c.2013132) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OH C.2002501-TRNE) |
| Enumeration Date | 2020-05-27 |
| Last Update Date | 2024-02-11 |