| NPI | 1578184495 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: OH C.2103443) |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YP2500X Counselor, Professional (Licence: OH E.2606542) | |
| Enumeration Date | 2020-05-01 |
| Last Update Date | 2026-02-20 |