| NPI | 1982118402 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OR C5659) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OH E.1700416) |
| Enumeration Date | 2017-11-20 |
| Last Update Date | 2026-03-02 |