| NPI | 1215769658 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 2084P0805X (Licence: MO 2024032607) |
| Enumeration Date | 2024-08-15 |
| Last Update Date | 2025-04-23 |