| NPI | 1417727983 |
|---|---|
| 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 |
| 174H00000X Health Educator | |
| Enumeration Date | 2024-01-05 |
| Last Update Date | 2024-09-25 |