| NPI | 1922542299 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MO 2019045185) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: OH E.1901421) |
| Enumeration Date | 2016-12-06 |
| Last Update Date | 2023-06-21 |