NPI | 1023679156 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CA 12661) |
Additional Taxonomies | 225400000X Rehabilitation Practitioner |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2019-06-28 |
Last Update Date | 2022-11-18 |