| NPI | 1841539475 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OH E.1000553) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: OH C.1000553) |
| Enumeration Date | 2013-02-01 |
| Last Update Date | 2020-11-18 |