| NPI | 1902141955 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: FL MH13320) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: OH C.1000022) |
| Enumeration Date | 2012-12-03 |
| Last Update Date | 2015-06-22 |