| NPI | 1124305305 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OH E.0900092) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MD LC4235) |
| Enumeration Date | 2011-11-15 |
| Last Update Date | 2013-06-25 |