| NPI | 1457854135 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OH E.1800683) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: OH c0500113) |
| Enumeration Date | 2018-03-09 |
| Last Update Date | 2022-04-25 |