| NPI | 1083103766 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OH C1801038) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OH C.1801038) |
| Enumeration Date | 2018-05-08 |
| Last Update Date | 2018-10-17 |