| NPI | 1528779642 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: OH C.2305689) |
| Additional Taxonomies | 101YP2500X Counselor Professional |
| Enumeration Date | 2022-12-09 |
| Last Update Date | 2024-06-13 |