| NPI | 1184933574 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: OH C.0900504) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OH C.0900504) |
| Enumeration Date | 2010-10-01 |
| Last Update Date | 2022-07-21 |