| NPI | 1063201267 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 104100000X Social Worker |
| Enumeration Date | 2025-05-05 |
| Last Update Date | 2025-08-13 |