| NPI | 1265053268 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: OH M.1800064)  | 
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OH C.1801061)  | 
| 106H00000X Marriage & Family Therapist (Licence: IN 85000346A)  | |
| Enumeration Date | 2020-04-30 | 
| Last Update Date | 2020-04-30 |