| NPI | 1013936004 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: OH E - 3216) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: OH E - 3216) |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2007-07-08 |