| NPI | 1205332921 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 101Y00000X Counselor (Licence: OH C.1800798-TRNE) |
| Enumeration Date | 2018-04-02 |
| Last Update Date | 2018-04-02 |