| NPI | 1144312919 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OH E0500370.SUPV) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OH C0500370) |
| Enumeration Date | 2006-09-29 |
| Last Update Date | 2013-03-17 |