| NPI | 1548072440 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: OH C.2607801) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH C.2406438-TRNE) |
| Enumeration Date | 2025-01-27 |
| Last Update Date | 2026-01-15 |