| NPI | 1740176080 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: PA 1064188) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2025-06-13 |
| Last Update Date | 2026-01-09 |