| NPI | 1093339491 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CT 67821) |
| Additional Taxonomies | 2085R0001X (Licence: CT 80998) |
| Enumeration Date | 2020-06-01 |
| Last Update Date | 2025-04-30 |