| NPI | 1043991375 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA CG61464163) |
| Enumeration Date | 2023-07-28 |
| Last Update Date | 2025-12-04 |