| NPI | 1073501631 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 66038) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OH RS141297) |
| 101YP2500X Counselor, Professional (Licence: OH E.00007850) | |
| Enumeration Date | 2005-10-07 |
| Last Update Date | 2010-12-06 |