| NPI | 1306118567 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YS0200X Counselor, School (Licence: OH OH3044897) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OH OH3044897) |
| Enumeration Date | 2012-02-03 |
| Last Update Date | 2012-02-03 |