| NPI | 1154148666 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PR 37396-R) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PR 17233-I) |
| Enumeration Date | 2024-09-25 |
| Last Update Date | 2025-05-20 |