| NPI | 1275253304 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: OH C.2305519) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH C.2204119-TRNE) |
| Enumeration Date | 2022-08-30 |
| Last Update Date | 2023-10-12 |