| NPI | 1831067370 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OR 10004385) |
| 163W00000X Registered Nurse (Licence: OR 10004385) | |
| Enumeration Date | 2025-10-27 |
| Last Update Date | 2026-07-16 |