| NPI | 1437491701 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OH C1300110) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: PA PC005957) |
| Enumeration Date | 2013-03-25 |
| Last Update Date | 2023-01-04 |