| NPI | 1154999456 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: RI LP05377) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: RI CLP05377) |
| Enumeration Date | 2021-06-14 |
| Last Update Date | 2024-02-28 |