| NPI | 1316450307 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: OH E.1901071) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: OH E.1901071) |
| Enumeration Date | 2017-11-13 |
| Last Update Date | 2021-03-30 |