NPI | 1205355930 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NY 015263) |
Additional Taxonomies | 1041S0200X Social Worker, School |
Enumeration Date | 2017-09-13 |
Last Update Date | 2025-08-04 |