| NPI | 1366947921 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OH E.2001822) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OH C1600236) |
| Enumeration Date | 2018-03-27 |
| Last Update Date | 2022-06-07 |