| NPI | 1598294886 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: OH E.1200109) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OH E1200109) |
| Enumeration Date | 2017-06-08 |
| Last Update Date | 2021-07-11 |