| NPI | 1003255183 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH INT.06008260-GRAD) |
| Enumeration Date | 2013-06-21 |
| Last Update Date | 2013-06-21 |