| NPI | 1427203629 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: KY 1551) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OH C . 0600527) |
| Enumeration Date | 2008-12-02 |
| Last Update Date | 2015-02-23 |