| NPI | 1619601580 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CA None) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA None) |
| Enumeration Date | 2022-07-14 |
| Last Update Date | 2022-07-18 |