| NPI | 1407268634 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: WI 100214) |
| Additional Taxonomies | 104100000X Social Worker (Licence: WI 8744) |
| Enumeration Date | 2014-05-22 |
| Last Update Date | 2023-06-19 |