| NPI | 1538445077 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: MN CC00242) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: OH E.0501253) |
| Enumeration Date | 2011-10-28 |
| Last Update Date | 2011-10-28 |