| NPI | 1881122794 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OH E.2002019) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OH 1600498) |
| Enumeration Date | 2017-05-23 |
| Last Update Date | 2020-12-02 |