| NPI | 1659590347 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OH 2338) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: OH E0002338) |
| Enumeration Date | 2007-04-24 |
| Last Update Date | 2012-03-27 |