| NPI | 1164923108 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PR 4530376) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: 0) | |
| Enumeration Date | 2018-02-26 |
| Last Update Date | 2023-08-25 |