| NPI | 1053039446 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OH E.2404843) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OH 1801572) |
| Enumeration Date | 2022-08-22 |
| Last Update Date | 2024-12-10 |