| NPI | 1235870312 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CO TL.0009326) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CO pending) |
| Enumeration Date | 2022-04-05 |
| Last Update Date | 2022-06-28 |