| NPI | 1194387258 |
|---|---|
| Former Name | EDRICK NICHOLAS PITTMAN |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: WA CO60943555) |
| Enumeration Date | 2019-06-28 |
| Last Update Date | 2021-01-20 |