| NPI | 1831643261 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: WA CO61074899) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA MC61079032) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-08-15 |
| Last Update Date | 2020-09-10 |