| NPI | 1992870794 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WV 2402) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OH E.0501178) |
| Enumeration Date | 2006-11-21 |
| Last Update Date | 2026-01-15 |