| NPI | 1134575145 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 6352000701) |
| Additional Taxonomies | 247200000X |
| Enumeration Date | 2016-05-09 |
| Last Update Date | 2022-06-17 |