| NPI | 1457244410 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CA 122765) |
| Additional Taxonomies | 104100000X Social Worker (Licence: CA 122765) |
| Enumeration Date | 2025-05-29 |
| Last Update Date | 2025-06-04 |