| NPI | 1518478213 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OH E2303877) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OH C.2103180) |
| Enumeration Date | 2017-10-20 |
| Last Update Date | 2023-11-17 |