| NPI | 1568694214 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: AK 649) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OH C0501343) |
| Enumeration Date | 2009-08-13 |
| Last Update Date | 2017-04-18 |