| NPI | 1134985542 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OH C.2406657) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OH C.2405604-TRNE) |
| Enumeration Date | 2024-02-23 |
| Last Update Date | 2024-12-12 |