| NPI | 1649757774 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: PA PC014677) |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YP2500X Counselor, Professional (Licence: OH C.1902389) | |
| Enumeration Date | 2018-07-21 |
| Last Update Date | 2023-04-11 |