| NPI | 1215343850 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OH E.1800641-SUPV) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OH 100094) |
| Enumeration Date | 2014-07-03 |
| Last Update Date | 2024-05-12 |