| NPI | 1073329975 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: KY 294871) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OH C2406280) |
| Enumeration Date | 2024-12-05 |
| Last Update Date | 2024-12-05 |