| NPI | 1861755399 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OH E.1100157) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OH C 1100157) |
| 101YP2500X Counselor, Professional (Licence: OH C 1100157) | |
| Enumeration Date | 2012-06-19 |
| Last Update Date | 2015-02-18 |