| NPI | 1780445411 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: OH C.2507184) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH C.2405455-TRNE) |
| Enumeration Date | 2024-01-19 |
| Last Update Date | 2025-06-12 |