| NPI | 1093503112 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 273Y00000X Rehabilitation Unit |
| Enumeration Date | 2025-04-28 |
| Last Update Date | 2026-07-23 |