| NPI | 1316460868 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OH e.2203232) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OH c.1700373) |
| Enumeration Date | 2017-07-17 |
| Last Update Date | 2023-01-24 |