| NPI | 1144505645 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OH C.2507640) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: TX 68349) |
| Enumeration Date | 2011-10-15 |
| Last Update Date | 2025-12-10 |