| NPI | 1578063814 |
|---|---|
| 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 |
| Enumeration Date | 2018-02-13 |
| Last Update Date | 2023-04-09 |