| NPI | 1083663470 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OH E0001996-SUPV) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OH E.0001966-SUPV) |
| Enumeration Date | 2006-05-10 |
| Last Update Date | 2017-07-28 |