| NPI | 1235117011 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC1900X Psychologist Counseling (Licence: OH P.7390) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: OH E.0700070-SUPV) |
| Enumeration Date | 2006-01-03 |
| Last Update Date | 2022-04-15 |