| NPI | 1467060467 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: OH E.2505735) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: OH C.2002448-TRNE) |
| Enumeration Date | 2020-07-16 |
| Last Update Date | 2025-10-01 |