| NPI | 1154967982 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: IL 180.012006) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OH E.2404580) |
| Enumeration Date | 2019-11-27 |
| Last Update Date | 2025-09-27 |