| NPI | 1366818825 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MI 3915805) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OH C1200119) |
| Enumeration Date | 2015-08-18 |
| Last Update Date | 2015-08-18 |