| NPI | 1366677064 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OH E.0600267) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: OH E 0600267) |
| Enumeration Date | 2009-05-26 |
| Last Update Date | 2022-08-14 |