| NPI | 1053439927 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OH E0000520) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: GA LPC002356) |
| Enumeration Date | 2007-03-27 |
| Last Update Date | 2025-09-11 |