| NPI | 1225045065 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: OH E0002651) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: PA PC001991) |
| Enumeration Date | 2006-08-02 |
| Last Update Date | 2016-12-12 |