| NPI | 1164313375 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MT MED-RES-LIC-159090) |
| Enumeration Date | 2025-07-14 |
| Last Update Date | 2025-07-14 |