| NPI | 1609502111 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OH C.2204655) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: OH C.2204655) |
| Enumeration Date | 2022-07-27 |
| Last Update Date | 2025-01-16 |