| NPI | 1013486273 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0000X (Licence: KY 57814) |
| Additional Taxonomies | 208VP0000X (Licence: IN 01089395A) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC 242841) | |
| Enumeration Date | 2018-11-17 |
| Last Update Date | 2024-06-24 |