| NPI | 1558937177 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: OH cdca.176548) |
| Additional Taxonomies | 405300000X Prevention Professional (Licence: OH ocpsa.161638) |
| Enumeration Date | 2021-06-03 |
| Last Update Date | 2021-06-03 |