| NPI | 1205589488 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OH C.2305203) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH C.2103699-TRNE) |
| Enumeration Date | 2022-01-28 |
| Last Update Date | 2023-07-10 |