| NPI | 1346874914 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OH E.2606922) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: OH C.2203893-TRNE) |
| 101Y00000X Counselor (Licence: OH C.2305397) | |
| Enumeration Date | 2020-02-23 |
| Last Update Date | 2026-04-10 |