| NPI | 1215394424 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OH E.1800638) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OH c1300277) |
| Enumeration Date | 2016-01-19 |
| Last Update Date | 2020-03-23 |