| NPI | 1255945986 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: VT 097.0136394) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: VT 097.0136392) |
| Enumeration Date | 2020-09-01 |
| Last Update Date | 2025-12-10 |