| NPI | 1750803581 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OH E.2303626) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OH 1500422) |
| Enumeration Date | 2017-07-13 |
| Last Update Date | 2023-12-26 |