| NPI | 1780189381 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: OH E.2303487) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: OH C.1801020) |
| Enumeration Date | 2018-03-26 |
| Last Update Date | 2023-05-02 |