| NPI | 1316196991 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: VA 0701005139) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OH E.0200022-SUPV) |
| Enumeration Date | 2008-09-18 |
| Last Update Date | 2012-12-19 |