| NPI | 1871558841 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WV 2210) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OH E4195) |
| Enumeration Date | 2006-04-20 |
| Last Update Date | 2016-01-26 |