| NPI | 1285300889 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 101Y00000X Counselor (Licence: OH C.2204226) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: OH C.2103312-TRNE) |
| Enumeration Date | 2021-08-23 |
| Last Update Date | 2022-06-09 |