| NPI | 1609250794 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OH C.1500274) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: KY Lpccca00218270) |
| Enumeration Date | 2015-07-17 |
| Last Update Date | 2016-02-16 |