| NPI | 1629654058 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OH C.2406128) |
| Enumeration Date | 2021-03-24 |
| Last Update Date | 2025-09-19 |