| NPI | 1912719923 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OH E.2404186) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: IL 180.007860) |
| Enumeration Date | 2025-01-25 |
| Last Update Date | 2025-01-25 |