| NPI | 1205160942 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: OH E.0700307) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: OH E.0700307) |
| Enumeration Date | 2009-09-29 |
| Last Update Date | 2017-02-09 |