| NPI | 1588831457 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OH E.0007596-SUPV) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MI 6401011009) |
| 101YP2500X Counselor, Professional (Licence: KY 104024) | |
| Enumeration Date | 2008-05-10 |
| Last Update Date | 2024-02-28 |