| NPI | 1336601376 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: OR 140910) |
| Enumeration Date | 2019-04-01 |
| Last Update Date | 2025-04-08 |