| NPI | 1366638256 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: TX 65624) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OH C.0501027) |
| Enumeration Date | 2007-09-24 |
| Last Update Date | 2015-06-25 |