| NPI | 1639758329 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: OH E.2303842) |
| Additional Taxonomies | 101Y00000X Counselor |
| 101Y00000X Counselor (Licence: OH C.2002842) | |
| Enumeration Date | 2021-04-07 |
| Last Update Date | 2023-11-06 |