| NPI | 1225308836 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: PA PC006856) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OH E0800066) |
| Enumeration Date | 2012-01-12 |
| Last Update Date | 2015-04-29 |