| NPI | 1548413461 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OH E0701097) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OH C.07010977) |
| Enumeration Date | 2008-10-23 |
| Last Update Date | 2019-04-01 |