| NPI | 1083941553 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OH E.0800099-SUPV) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OH C0800099) |
| Enumeration Date | 2009-11-04 |
| Last Update Date | 2017-01-17 |