| NPI | 1124680178 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| 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: MI 43-51045171) |
| Enumeration Date | 2019-06-30 |
| Last Update Date | 2023-05-12 |