| NPI | 1851685952 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: AZ LAC-13380) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OH E.1500016) |
| Enumeration Date | 2011-06-06 |
| Last Update Date | 2025-06-12 |