| NPI | 1093517054 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program | 
| Additional Taxonomies | 101YS0200X Counselor, School | 
| Enumeration Date | 2025-03-27 | 
| Last Update Date | 2025-03-27 |