| NPI | 1053657056 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 101Y00000X Counselor (Licence: OH C.1200604-TRNE) |
| Enumeration Date | 2012-12-19 |
| Last Update Date | 2016-08-11 |