| NPI | 1609354547 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 104100000X Social Worker |
| Enumeration Date | 2018-08-02 |
| Last Update Date | 2018-08-03 |