| NPI | 1477669463 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OH E-0002472) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OH E.0002472) |
| Enumeration Date | 2006-08-22 |
| Last Update Date | 2023-08-16 |