| NPI | 1013259340 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: KY 265310) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OH C 1200416) |
| Enumeration Date | 2013-03-25 |
| Last Update Date | 2021-04-08 |