| NPI | 1467484162 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: OH E.0003691) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: KY 574) |
| Enumeration Date | 2006-07-06 |
| Last Update Date | 2015-04-20 |