| NPI | 1730517087 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OH E.1600066) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OH C.1200356) |
| Enumeration Date | 2013-10-24 |
| Last Update Date | 2018-08-02 |