| 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 |