| NPI | 1700134319 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MI 6401009234) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OH E.2202886) |
| Enumeration Date | 2012-08-29 |
| Last Update Date | 2023-03-31 |