| NPI | 1497293195 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WS0200X Registered Nurse, School (Licence: TX 600719) |
| Additional Taxonomies | 101YS0200X Counselor, School |
| 103TS0200X Psychologist, School | |
| 235Z00000X Speech-Language Pathologist, | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-02-02 |
| Last Update Date | 2017-02-02 |