| NPI | 1003334152 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 171W00000X Contractor |
| Enumeration Date | 2017-09-08 |
| Last Update Date | 2017-09-21 |