| NPI | 1831359595 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OH E.2303482-SUPV) | 
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: TX 17129) | 
| Enumeration Date | 2008-06-16 | 
| Last Update Date | 2025-09-26 |