| NPI | 1043329667 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: OH E2110) |
| Additional Taxonomies | 103TP2701X Psychologist Group Psychotherapy |
| Enumeration Date | 2006-08-29 |
| Last Update Date | 2007-07-08 |