| NPI | 1891487450 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 101YS0200X Counselor, School |
| Enumeration Date | 2023-05-23 |
| Last Update Date | 2023-05-23 |