| NPI | 1831359595 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OH E.2303482-SUPV) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: TX 17129) |
| Enumeration Date | 2008-06-16 |
| Last Update Date | 2025-09-26 |