| NPI | 1639476559 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: OH C.0900657) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: OH C.0900657) |
| Enumeration Date | 2011-02-13 |
| Last Update Date | 2011-02-13 |