| NPI | 1659793636 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OH E.2404458) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: ME CC4635) |
| Enumeration Date | 2014-01-10 |
| Last Update Date | 2025-01-28 |