| NPI | 1013326693 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: OH E.0700424-SUPV) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OH 0700424) |
| Enumeration Date | 2014-08-07 |
| Last Update Date | 2021-02-09 |