| NPI | 1174909097 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OH E.1700445) |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| Enumeration Date | 2015-08-03 |
| Last Update Date | 2018-11-07 |