| NPI | 1881118974 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CA 9540) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CA APCC5547) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-07-31 |
| Last Update Date | 2021-05-20 |