| NPI | 1356495287 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: OH E.0700338-SUPV) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: IN 39001804A) |
| Enumeration Date | 2007-01-22 |
| Last Update Date | 2018-05-03 |