| NPI | 1750928008 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OH E.2303684) |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YP2500X Counselor, Professional (Licence: OH C.2103488) | |
| Enumeration Date | 2019-12-05 |
| Last Update Date | 2024-04-18 |