| NPI | 1669952032 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| Enumeration Date | 2018-08-15 |
| Last Update Date | 2019-09-20 |