| NPI | 1245852359 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CA LPCC354) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OH E0008150) |
| Enumeration Date | 2020-05-12 |
| Last Update Date | 2020-05-12 |