| NPI | 1114063799 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OH E4291) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MI 6401005557) |
| Enumeration Date | 2007-01-30 |
| Last Update Date | 2013-04-17 |