| NPI | 1720294614 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: PA PC002299) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MI 6401005427) |
| 101YP2500X Counselor, Professional (Licence: OH C.0005486) | |
| Enumeration Date | 2007-05-15 |
| Last Update Date | 2024-11-21 |