| NPI | 1255560595 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2088P0231X (Licence: AL 35045) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MO 2009017783) |
| Enumeration Date | 2009-07-08 |
| Last Update Date | 2016-05-24 |