| NPI | 1467514596 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OH E1227 PCC-S) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: OH 3877) |
| Enumeration Date | 2006-12-14 |
| Last Update Date | 2007-07-08 |