| NPI | 1336035286 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: MD ADT2818) |
| Enumeration Date | 2025-06-17 |
| Last Update Date | 2025-06-17 |