| NPI | 1225523707 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT232055) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MO 2018014813) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: VA 0116034994) | |
| Enumeration Date | 2018-06-26 |
| Last Update Date | 2024-06-24 |