| NPI | 1174141543 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OH E.1300019) |
| Additional Taxonomies | 101YS0200X Counselor, School (Licence: OH OH3098144) |
| Enumeration Date | 2020-07-11 |
| Last Update Date | 2021-06-01 |