| NPI | 1740613090 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: OH C1300442) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: OH C 1300442-TRNE) |
| Enumeration Date | 2013-08-09 |
| Last Update Date | 2015-04-17 |