NPI | 1134589807 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OH E.2203119) |
Additional Taxonomies | 101Y00000X Counselor (Licence: OH C.1000369) |
Enumeration Date | 2016-02-24 |
Last Update Date | 2022-10-03 |