| NPI | 1730293499 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: OH E0000953) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: OH 2871) |
| Enumeration Date | 2006-08-19 |
| Last Update Date | 2007-07-08 |