| NPI | 1699012898 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor |
| Additional Taxonomies | 101Y00000X Counselor (Licence: NV CP1205) |
| 101Y00000X Counselor (Licence: OH E.200.1900) | |
| Enumeration Date | 2013-01-08 |
| Last Update Date | 2024-05-09 |