| NPI | 1609302355 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: SC 6518) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OH C.1500441) |
| Enumeration Date | 2017-05-02 |
| Last Update Date | 2017-05-02 |