| NPI | 1013330505 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OH E.1600028) |
| Additional Taxonomies | 101Y00000X Counselor |
| 106H00000X Marriage & Family Therapist (Licence: OH M.1500025) | |
| Enumeration Date | 2014-02-04 |
| Last Update Date | 2018-12-06 |