| NPI | 1093838682 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NC 8352) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OH E 0002213) |
| Enumeration Date | 2007-04-09 |
| Last Update Date | 2014-06-27 |