| NPI | 1093013757 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OH C.0700228-CR) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OH C.0700228) |
| Enumeration Date | 2011-03-04 |
| Last Update Date | 2011-03-04 |