| NPI | 1801175245 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OH E.0900173) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: OH C.0900173) |
| Enumeration Date | 2011-08-16 |
| Last Update Date | 2013-08-16 |