| NPI | 1821831900 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| 106H00000X Marriage & Family Therapist | |
| Enumeration Date | 2024-06-17 |
| Last Update Date | 2024-06-17 |