| NPI | 1053058339 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL 35172) |
| Enumeration Date | 2022-05-17 |
| Last Update Date | 2024-01-25 |