| NPI | 1639220361 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OH E050039) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: FL TPMC3856) |
| 101YP2500X Counselor, Professional (Licence: SC 11882) | |
| Enumeration Date | 2007-01-16 |
| Last Update Date | 2026-06-04 |