| NPI | 1790102119 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OH E.0003037) |
| Additional Taxonomies | 103TS0200X Psychologist, School (Licence: OH E0003037) |
| Enumeration Date | 2014-03-24 |
| Last Update Date | 2020-08-25 |