| NPI | 1245685429 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X (Licence: PA MD465431) |
| Additional Taxonomies | 2086S0129X (Licence: CA A-185880) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-04-26 |
| Last Update Date | 2025-09-23 |