| NPI | 1376964239 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OH E.2202883) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: PA PC008329) |
| Enumeration Date | 2013-12-19 |
| Last Update Date | 2026-09-03 |