NPI | 1063407369 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OH E4333) |
Additional Taxonomies | 101Y00000X Counselor (Licence: OH E4333) |
101YP2500X Counselor, Professional (Licence: OH E4333) | |
Enumeration Date | 2005-09-13 |
Last Update Date | 2018-04-20 |