| NPI | 1285090860 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OH C.1500591) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: OH M.1600031) |
| Enumeration Date | 2016-01-12 |
| Last Update Date | 2018-03-17 |