| NPI | 1942363007 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MI 6401016798) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OH E3743) |
| Enumeration Date | 2006-12-19 |
| Last Update Date | 2024-02-26 |