| NPI | 1306191069 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: OH C0900153) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: OH 111126) |
| 101YM0800X Counselor Mental Health (Licence: OH C0900153) | |
| 106H00000X Marriage & Family Therapist (Licence: OH C0900153) | |
| Enumeration Date | 2012-07-18 |
| Last Update Date | 2012-07-18 |