| NPI | 1194400085 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OH C.2406123) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH C.2304754-TRNE) |
| Enumeration Date | 2023-06-19 |
| Last Update Date | 2024-06-07 |