| NPI | 1639758329 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OH E.2303842) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: OH C.2002842) |
| Enumeration Date | 2021-04-07 |
| Last Update Date | 2025-08-27 |