| NPI | 1215255682 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OH E.0800186) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OH C.0800186) |
| Enumeration Date | 2010-05-11 |
| Last Update Date | 2024-08-28 |