| NPI | 1992076541 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OH E.1000349) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OH C.1000349-CR) |
| Enumeration Date | 2012-01-13 |
| Last Update Date | 2016-12-12 |