| NPI | 1881208569 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CA 121043) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 121043) |
| Enumeration Date | 2020-09-01 |
| Last Update Date | 2021-08-02 |