| NPI | 1487096319 |
|---|---|
| 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: VA A64268179) |
| Enumeration Date | 2013-07-19 |
| Last Update Date | 2021-11-04 |