| NPI | 1194473041 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 104100000X Social Worker | |
| 106H00000X Marriage & Family Therapist | |
| 172V00000X Community Health Worker | |
| Enumeration Date | 2022-03-10 |
| Last Update Date | 2024-08-23 |