| NPI | 1619384625 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OH E.1800656) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OH C.1200544) |
| Enumeration Date | 2014-07-22 |
| Last Update Date | 2019-01-13 |