| NPI | 1477583094 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OH E.2404619) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: TN 1196) |
| Enumeration Date | 2006-07-03 |
| Last Update Date | 2026-01-07 |