| NPI | 1033109087 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OH E0002899) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: AR P0709052) |
| Enumeration Date | 2005-10-21 |
| Last Update Date | 2015-01-21 |