| NPI | 1497246938 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: OH E.2001824) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: SC 9842) |
| Enumeration Date | 2018-05-21 |
| Last Update Date | 2024-09-09 |