| NPI | 1639641079 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OH C.2002894) |
| Additional Taxonomies | 405300000X Prevention Professional (Licence: OH RA.162289) |
| 101Y00000X Counselor (Licence: OH C.1801343-TRNE) | |
| 251S00000X (Licence: OH CDCA.172862) | |
| Enumeration Date | 2018-12-26 |
| Last Update Date | 2020-09-01 |