| NPI | 1558388033 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OH E1101) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: OH 4622) |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2007-07-08 |