| NPI | 1174763783 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OH E-2588) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL MH10055) |
| Enumeration Date | 2009-02-23 |
| Last Update Date | 2011-07-13 |