| NPI | 1760048953 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: WA CG60972927) |
| Enumeration Date | 2019-05-14 |
| Last Update Date | 2021-03-30 |