| NPI | 1306198809 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OH E3591) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: GA LPC006098) |
| Enumeration Date | 2012-10-08 |
| Last Update Date | 2012-10-08 |