| NPI | 1346780970 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OH E.1901120) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: OH C.1500555) |
| Enumeration Date | 2017-03-01 |
| Last Update Date | 2022-10-24 |