| NPI | 1912425653 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: OH C.1700179) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: OH F.1900093) |
| Enumeration Date | 2017-09-01 |
| Last Update Date | 2020-01-17 |