| NPI | 1891059770 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: OH E.1000605) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: OH C.1000605) |
| Enumeration Date | 2012-06-26 |
| Last Update Date | 2023-11-19 |