| NPI | 1548830680 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: OH LICDC.162311) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: OH C.2204618) |
| Enumeration Date | 2021-06-30 |
| Last Update Date | 2023-12-21 |