| NPI | 1497158323 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OH E.1300658) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OH C.1300658) |
| Enumeration Date | 2014-10-07 |
| Last Update Date | 2017-01-10 |