| NPI | 1801348032 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 101Y00000X Counselor |
| 101Y00000X Counselor (Licence: KY 174349) | |
| Enumeration Date | 2016-11-04 |
| Last Update Date | 2023-05-10 |