| NPI | 1346281417 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: OH E0700275) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: KY 0163) |
| Enumeration Date | 2006-06-09 |
| Last Update Date | 2015-09-24 |