| NPI | 1124513627 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| 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: DC MTL004862) |
| Enumeration Date | 2018-06-27 |
| Last Update Date | 2021-06-21 |