| NPI | 1366790396 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OH E.1200424) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OH C.1200424) |
| Enumeration Date | 2012-08-23 |
| Last Update Date | 2015-10-01 |