| NPI | 1215475132 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0700X (Licence: GA 100674) |
| Additional Taxonomies | 2085N0700X (Licence: OH 34.016371) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-02-11 |
| Last Update Date | 2024-07-15 |