| NPI | 1720431091 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OH E1700008) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OH C1300130) |
| Enumeration Date | 2016-07-21 |
| Last Update Date | 2021-10-27 |