| NPI | 1225262520 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: OH 4581) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OH E1282-SUPV) |
| Enumeration Date | 2009-05-14 |
| Last Update Date | 2021-07-15 |