| NPI | 1902388986 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: WA MC61023038) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: OH C.1700825) |
| Enumeration Date | 2018-09-05 |
| Last Update Date | 2020-04-02 |