| NPI | 1912463225 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OH E.2404605) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: OH C.1901560-TRNE) |
| 101Y00000X Counselor (Licence: OH C.1902108) | |
| Enumeration Date | 2019-02-12 |
| Last Update Date | 2024-08-30 |