| NPI | 1720313638 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OH C 0800106) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OH E.0800106) |
| Enumeration Date | 2009-10-09 |
| Last Update Date | 2016-02-04 |