| NPI | 1801963038 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OH C0005518) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OH c0005518) |
| Enumeration Date | 2006-11-30 |
| Last Update Date | 2007-07-08 |