| NPI | 1164741559 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: E.0800343) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OH C.0800343) |
| Enumeration Date | 2010-05-25 |
| Last Update Date | 2013-01-08 |