| NPI | 1922753367 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OH E.2505462) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OH C.2204291) |
| Enumeration Date | 2022-02-15 |
| Last Update Date | 2025-07-03 |