| NPI | 1326002585 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: LA 3776) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: OH F0500003) |
| Enumeration Date | 2006-04-14 |
| Last Update Date | 2012-04-12 |