| NPI | 1770367542 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OH C.2406518) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: OH C.2406518) |
| Enumeration Date | 2023-08-23 |
| Last Update Date | 2024-11-10 |