| NPI | 1235989534 |
|---|---|
| Former Name | CHARLES GEORGE ATHANASIOUS MAGGITAS |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2024-03-27 |
| Last Update Date | 2024-06-22 |