| NPI | 1326259607 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OH #0001744) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: KY #0434) |
| 103T00000X Psychologist (Licence: OK #1173) | |
| Enumeration Date | 2007-05-25 |
| Last Update Date | 2014-04-27 |