| NPI | 1568069029 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: OH E.2404423) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: OH C.2002740-TRNE) |
| Enumeration Date | 2020-10-07 |
| Last Update Date | 2024-06-26 |