| NPI | 1164921201 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: OH E.2001772) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: OH C1600546) |
| Enumeration Date | 2018-02-05 |
| Last Update Date | 2020-07-06 |