| NPI | 1578033502 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OH E.2303564) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: OH C.2002538) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-12-03 |
| Last Update Date | 2025-03-12 |