| NPI | 1083126411 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: OH C.2103290) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: OH LICDC.161836) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-10-25 |
| Last Update Date | 2024-07-29 |