| NPI | 1477033033 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: CA 11072) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: CA 11072) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-08-14 |
| Last Update Date | 2023-11-07 |