| NPI | 1063953263 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OH E.2102390) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OH C.1700259) |
| Enumeration Date | 2017-03-20 |
| Last Update Date | 2021-07-22 |