| NPI | 1194908244 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: OH E0500400) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: OH E0500400) |
| Enumeration Date | 2007-12-12 |
| Last Update Date | 2018-02-06 |