| NPI | 1164165171 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: Student-Healthcare) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NY Student) |
| Enumeration Date | 2022-04-18 |
| Last Update Date | 2022-04-19 |