| NPI | 1528315322 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: OH E1700432) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: OH C1200279) |
| Enumeration Date | 2012-08-10 |
| Last Update Date | 2020-01-15 |