| NPI | 1174981666 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OH E.1901337) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OH C1700293) |
| Enumeration Date | 2016-01-29 |
| Last Update Date | 2022-05-06 |