| NPI | 1912246745 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OH C0800252) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OH M0900017) |
| Enumeration Date | 2013-02-14 |
| Last Update Date | 2013-02-14 |