| NPI | 1942775069 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 225XM0800X Occupational Therapist, Mental Health |
| Enumeration Date | 2018-10-04 |
| Last Update Date | 2018-10-04 |