| NPI | 1316149347 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OH E0500783) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: NY 004830-1) |
| 101YM0800X Counselor, Mental Health (Licence: NY 004830-1) | |
| 101YP2500X Counselor, Professional (Licence: OH E0500783) | |
| Enumeration Date | 2007-06-01 |
| Last Update Date | 2014-01-14 |