| NPI | 1164098760 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OH E.2404527) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: OH C.2103185-TRNE) |
| Enumeration Date | 2021-06-03 |
| Last Update Date | 2025-04-09 |