| NPI | 1619741238 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NY 794818) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NY 794818) |
| 101YS0200X Counselor, School (Licence: NY 794818) | |
| 174H00000X Health Educator (Licence: NY 794818) | |
| Enumeration Date | 2023-11-14 |
| Last Update Date | 2023-12-11 |