| NPI | 1851912604 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH c.2002418) |
| Enumeration Date | 2020-05-04 |
| Last Update Date | 2021-10-06 |