| NPI | 1407148869 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OH E0701078) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: OH E0701078) |
| 101YP2500X Counselor, Professional (Licence: OH E.0701078) | |
| Enumeration Date | 2011-05-04 |
| Last Update Date | 2023-01-01 |