| NPI | 1821349812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OH E.1400023-SUPV) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OH C .1000029) |
| Enumeration Date | 2012-10-01 |
| Last Update Date | 2019-02-26 |