| NPI | 1174932578 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CA 117493578) |
| Additional Taxonomies | 101Y00000X Counselor |
| Enumeration Date | 2014-08-11 |
| Last Update Date | 2023-09-02 |