| NPI | 1235524117 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OH E1700314) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OH C1300760) |
| Enumeration Date | 2015-03-30 |
| Last Update Date | 2019-06-05 |