| NPI | 1134589807 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OH E.2203119) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: OH C.1000369) |
| Enumeration Date | 2016-02-24 |
| Last Update Date | 2022-10-03 |