| NPI | 1396919437 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OH E0001739-SUPV) |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: OH 5599) |
| Enumeration Date | 2008-04-19 |
| Last Update Date | 2022-05-23 |