| NPI | 1447673850 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: OH E.1600080) |
| Additional Taxonomies | 101YS0200X Counselor, School (Licence: OH OH3252984) |
| Enumeration Date | 2014-01-22 |
| Last Update Date | 2017-02-11 |