| NPI | 1407231574 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: OH E.1800809) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: OH C.1400686) |
| Enumeration Date | 2015-07-29 |
| Last Update Date | 2024-03-19 |