| NPI | 1134324528 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X (Licence: OR MD197064) |
| Additional Taxonomies | 2086S0129X (Licence: UT 289654-1205) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2007-06-18 |
| Last Update Date | 2021-10-29 |