| NPI | 1275267932 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist |
| 225C00000X Rehabilitation Counselor | |
| Enumeration Date | 2022-07-10 |
| Last Update Date | 2022-07-10 |