| NPI | 1871011460 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: OH E.2102668) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: OH C1300687) |
| Enumeration Date | 2017-09-02 |
| Last Update Date | 2021-12-14 |