| NPI | 1982363453 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OH C.2304857) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: OH C.2103639-TRNE) |
| Enumeration Date | 2021-12-13 |
| Last Update Date | 2023-02-03 |