| NPI | 1982376786 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OH E.2505702) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OH C.2204611) |
| 101Y00000X Counselor (Licence: OH C.2103537-TRNE) | |
| Enumeration Date | 2021-09-30 |
| Last Update Date | 2025-09-05 |