| NPI | 1194189811 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OH E1800564) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: OH C0601082) |
| Enumeration Date | 2016-04-08 |
| Last Update Date | 2018-03-06 |