| NPI | 1992331722 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OH E.2404071) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: OH C.210322) |
| Enumeration Date | 2020-03-12 |
| Last Update Date | 2024-02-07 |