| NPI | 1164760088 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor |
| Additional Taxonomies | 104100000X Social Worker |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-01-28 |
| Last Update Date | 2014-06-25 |