| NPI | 1447693536 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: OH LCDC.101162-3) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: OH C.0700464-TRNE) |
| Enumeration Date | 2013-04-09 |
| Last Update Date | 2013-04-09 |