NPI | 1386622934 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OH E.0008231-SUPV) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: VA 0701002759) |
Enumeration Date | 2006-01-04 |
Last Update Date | 2012-01-13 |