| NPI | 1780276741 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH C2002879-TRNE) |
| Enumeration Date | 2021-02-10 |
| Last Update Date | 2022-12-22 |