| NPI | 1114512852 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OH C.2204334) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH C.2002869-TRNE) |
| Enumeration Date | 2021-03-04 |
| Last Update Date | 2024-10-11 |