| NPI | 1144749573 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: PA PC012043) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: OH C.1700692) |
| Enumeration Date | 2017-09-18 |
| Last Update Date | 2021-09-07 |