| NPI | 1033366745 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0129X (Licence: CT 56696) |
| Additional Taxonomies | 2086S0129X (Licence: NJ 25MA09308000) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2008-08-25 |
| Last Update Date | 2025-12-04 |