| NPI | 1083008346 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X (Licence: KY 54960) |
| Additional Taxonomies | 2086S0129X (Licence: IN 01085680A) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-03-25 |
| Last Update Date | 2023-06-08 |