| NPI | 1730453143 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: OH E.0900596-SUPV) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: OH E.0900596) |
| 101YP2500X Counselor Professional (Licence: OH C0900596-CR) | |
| Enumeration Date | 2012-03-02 |
| Last Update Date | 2023-12-19 |