| NPI | 1073967105 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OH E.2001657) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH C.1500836-TRNE) |
| 101YM0800X Counselor, Mental Health (Licence: OH C.1700556) | |
| Enumeration Date | 2016-04-14 |
| Last Update Date | 2020-03-05 |