| NPI | 1124033840 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OH E.0004356-SUPV) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OH E4356) |
| Enumeration Date | 2006-07-30 |
| Last Update Date | 2021-01-21 |