| NPI | 1902632649 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: OH C.2507427) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OH C.2406088-TRNE) |
| Enumeration Date | 2024-09-10 |
| Last Update Date | 2025-08-27 |