| NPI | 1588700389 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OH E0500582) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OH C0500582) |
| Enumeration Date | 2007-01-29 |
| Last Update Date | 2010-12-22 |