| NPI | 1245589027 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CA IMF76289) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| Enumeration Date | 2012-09-07 |
| Last Update Date | 2015-06-29 |