| NPI | 1972227023 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OH E.2505530) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OH C.2305317) |
| Enumeration Date | 2022-10-03 |
| Last Update Date | 2025-11-20 |