| NPI | 1831826601 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH C.2103441-TRNE) |
| Enumeration Date | 2022-08-02 |
| Last Update Date | 2023-07-18 |