| NPI | 1821535634 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OH E0001543) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: PA PS002965L) |
| Enumeration Date | 2017-01-31 |
| Last Update Date | 2017-01-31 |