| NPI | 1427625482 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: CA APCC5527) |
| Enumeration Date | 2021-06-08 |
| Last Update Date | 2023-04-22 |