| NPI | 1982053922 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OH E.1901542) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OH C1500377) |
| Enumeration Date | 2016-06-09 |
| Last Update Date | 2019-12-27 |