| NPI | 1871514919 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: WV goldcard) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: MO 2003024989) |
| Enumeration Date | 2006-07-22 |
| Last Update Date | 2008-09-22 |