| NPI | 1245952548 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CA 12920) |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2022-09-13 |
| Last Update Date | 2025-08-26 |