| NPI | 1366781015 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH-15863) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OH C 1100207) |
| Enumeration Date | 2013-01-31 |
| Last Update Date | 2020-01-31 |