| NPI | 1396399630 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OH E.2607470) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: OH C.2002903) |
| Enumeration Date | 2019-07-25 |
| Last Update Date | 2026-08-12 |