| NPI | 1033470604 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X (Licence: PA MD489790) |
| Additional Taxonomies | 2085R0001X (Licence: IA MD-44201) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC 182817) | |
| Enumeration Date | 2012-05-31 |
| Last Update Date | 2025-07-11 |