| NPI | 1427792274 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CA 135461) |
| Enumeration Date | 2022-04-26 |
| Last Update Date | 2026-03-17 |