| NPI | 1497378616 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor |
| Additional Taxonomies | 101Y00000X Counselor (Licence: OH C.2103771) |
| 101Y00000X Counselor (Licence: OR C7584) | |
| Enumeration Date | 2020-05-21 |
| Last Update Date | 2025-08-18 |