| NPI | 1881137172 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OH C1500525) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: OH E.2102599) |
| Enumeration Date | 2016-11-18 |
| Last Update Date | 2024-12-16 |