| NPI | 1902369762 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA APCC8423) |
| Enumeration Date | 2019-04-09 |
| Last Update Date | 2022-06-30 |