| NPI | 1396010302 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OH E.1800962) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OH C1100007) |
| Enumeration Date | 2012-03-09 |
| Last Update Date | 2021-02-08 |