| NPI | 1679329544 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OH C.2406137) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OH C.2304573-TRNE) |
| Enumeration Date | 2024-04-30 |
| Last Update Date | 2024-06-11 |