| NPI | 1679143630 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CA 1679143630) |
| Additional Taxonomies | 101Y00000X Counselor |
| Enumeration Date | 2021-06-30 |
| Last Update Date | 2022-07-06 |