| NPI | 1750158804 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: PA PC016545) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OH E.2404008) |
| Enumeration Date | 2023-12-08 |
| Last Update Date | 2025-05-25 |