| NPI | 1053549279 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: OH C.0600602) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: OH C.0600602) |
| Enumeration Date | 2009-06-25 |
| Last Update Date | 2018-11-30 |