| NPI | 1164190641 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: OH C.2304813) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: OH C.2103474-TRNE) |
| Enumeration Date | 2021-08-31 |
| Last Update Date | 2023-01-25 |