| NPI | 1275092074 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0700X (Licence: AZ 76252) |
| Additional Taxonomies | 2085N0700X (Licence: MD D0091636) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-03-19 |
| Last Update Date | 2025-10-15 |