| NPI | 1801581210 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 104100000X Social Worker (Licence: UT 13980427-3503) |
| Enumeration Date | 2023-04-11 |
| Last Update Date | 2024-08-07 |