| NPI | 1013880038 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO LPC.0022836) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OH E.2606081) |
| Enumeration Date | 2025-09-25 |
| Last Update Date | 2026-02-06 |