| NPI | 1891981791 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: LA 5048) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OH 0008369) |
| Enumeration Date | 2007-09-24 |
| Last Update Date | 2022-09-22 |