| NPI | 1912033283 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CA 74833) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 74833) |
| Enumeration Date | 2007-02-23 |
| Last Update Date | 2017-01-11 |