| NPI | 1689856668 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: VA 07001013937) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: VA 07010113937) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2007-11-30 |
| Last Update Date | 2024-09-16 |