| NPI | 1427450451 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OH E.1600046-SUPV) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OH C1300022) |
| Enumeration Date | 2014-09-22 |
| Last Update Date | 2021-09-28 |