| NPI | 1285033464 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 1041S0200X Social Worker, School (Licence: UT 9858818-3501) |
| Enumeration Date | 2014-08-14 |
| Last Update Date | 2022-05-24 |