| NPI | 1427169945 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: OH E.0500718) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: OH E.0500718) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2020-11-02 |