| NPI | 1710493366 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: OH E.1800623-SUPV) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: OH C.1400157) |
| Enumeration Date | 2017-12-19 |
| Last Update Date | 2019-06-25 |