| NPI | 1326440728 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OH e.1800863) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OH C.1300592) |
| Enumeration Date | 2014-09-17 |
| Last Update Date | 2019-01-25 |