| NPI | 1164057295 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC 310183) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC BENA-ZNEQZ2) |
| Enumeration Date | 2020-03-09 |
| Last Update Date | 2022-05-25 |