| NPI | 1013378470 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OH E1901459) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OH C1500082) |
| Enumeration Date | 2016-03-14 |
| Last Update Date | 2020-03-09 |