| NPI | 1013306505 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OH E.1800803) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OH C.1300589) |
| Enumeration Date | 2015-01-21 |
| Last Update Date | 2018-08-27 |