| NPI | 1578082202 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: OH E.2001722-SUPV) |
| Additional Taxonomies | 101YP2500X Counselor Professional |
| Enumeration Date | 2017-09-13 |
| Last Update Date | 2024-09-04 |