| NPI | 1265100457 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MA 293154) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MA 0000000PENDING) |
| Enumeration Date | 2021-09-01 |
| Last Update Date | 2022-09-01 |