| NPI | 1629305586 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: OH E.0600346) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OH E.0600346) |
| Enumeration Date | 2009-11-12 |
| Last Update Date | 2020-10-12 |