| NPI | 1679873012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OH E.0500283-SUPV) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: KY 1144) |
| Enumeration Date | 2010-11-02 |
| Last Update Date | 2019-12-18 |