| NPI | 1194195503 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 101Y00000X Counselor (Licence: NE 11848) |
| Enumeration Date | 2015-09-28 |
| Last Update Date | 2021-10-26 |