| NPI | 1477057388 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OH E.2001770) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OH C.1800900) |
| Enumeration Date | 2018-03-23 |
| Last Update Date | 2020-06-29 |