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 |