| NPI | 1134810385 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OH C2405962) |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| Enumeration Date | 2023-05-18 |
| Last Update Date | 2024-05-13 |