| NPI | 1871458430 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: VT 097.0135505) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: VT 097.0135505) |
| Enumeration Date | 2025-12-17 |
| Last Update Date | 2026-03-16 |