| NPI | 1093174641 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 208D00000X General Practice (Licence: MI 4351048467) |
| 247200000X Technician, Other | |
| Enumeration Date | 2016-02-10 |
| Last Update Date | 2022-05-25 |